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objective To observe the influence of hemodynamic changes caused by extracranial carotid stenosis on the plaque stability, and analyze the relationship of cerebral infarction classification,criminal artery stenosis degree and plaque stability to offer evidence for evalu-ating nosogenesis,clinical diagnosis,treatment and prevention of cerebral infarction. Methods CDFI,CTA were performed in 168 patients with acute cerebral infarction,some moderate and severe and occlusive carotid artery which were demonstrated by CTA and CDFI were further checked by DSA during convalescence. Totally 168 acute cerebral infarction patients were divided into 5 groups based on the criminal artery stenosis degree. To evaluate the plaque stability and flow field changes with CDFI and CTA,OCSP clinical classification and brain image clas-sification were finished according to CTA. Patients were classified into 4 subtypes,namely cortical infarction,basal ganglion infarction,corona radiata infarction and posterior infarction,according to the lesion distributions. Observe the changes of flow field and stability of plaque,and compare the relationship between different degree of stenosis and the classification of lesion of infarction. Results Among the 168 criminal arteries,there was 17. 9% of normal,22. 6% of mild stenosis,30. 9% of moderate stenosis,14. 8% of severe stenosis,and 14. 3% of occlu-sion,and the moderate stenosis proportion was the highest. When the stenosis degree was over 50%,it may lead to the changes of flow field, speeding up of blood flow,forming of turbulent flow,and increasing of plaque instability in which lipid plaque and admixture plaque was the highest. PACI is the commonest in all moderate groups. Admixture plaque is usually seen in severe stenosis and occlusion, while fibrous plaque is usually seen in mild stenosis. Conclusion Moderate carotid stenosis may lead to the increase of plaque instability as a result of the changes of flow field,and it may prone to artery-artery embolization.
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Objective To systematically evaluate the relationship between atherosclerotic renal artery stenosis (ARAS) and cor‐onary artery disease (CAD) and peripheral arterial disease (PAD) .Methods We gathered all case‐control studies about the correla‐tion of ARAS with CAD and PAD in the following databases:Cochrane library ,PubMed ,EMBASE ,Web of science until April , 2014 .Two reviewers extracted all relevant datas from the screened documents independently according to exclusion and inclusion criteria ,RevMan 5 .2 software were used to conduct Meta‐analysis .Results Fourteen trials were included .Meta‐analysis showed that :the OR (95% CI)of CAD with 1 vascular lesions ,2 vascular lesions ,3 vascular lesions and left main stenosis ,PAD and ARAS were 0 .70(0 .59-0 .82) ,1 .28(1 .10 -1 .48) ,2 .09(1 .69 -2 .59) ,1 .82(1 .40 -2 .36) ,3 .68(2 .21 -6 .10) with statistical signifi‐cance (P<0 .05) .Conclusion CAD with 2 vascular lesions ,3 vascular lesions and left main stenosis ,PAD were connected with ARAS ,CAD with 1 vascular lesions has little relationship with ARAS .
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Objective To analyze the imageological characteristics of intracranial vascular multiple stenosis aneurysms and to e-valuate the influence of cerebral vascular stenosis caused hemodynamic change on the aneurysm occurrence .Methods The clinical data of 30 inpatients with intracranial arterial multiple stenosis aneurysms diagnosed by CTA and DSA ,who were hospitalized due to ischemic cerebrovascular disease in the neurology department of 251 Hospital of Beijing Military Region from January 2007 to May 2012 ,were retrospectively analyzed and taken as the observation group ;contemporaneous 30 cases of aneurysm without in-tracranial and extracranial arterial stenosis admitted to the neurosurgery department were taken as the control group .The gender , age of onset ,number of aneurysms ,whether or not complicating hypertension ,diabetes ,smoking ,hyperlipemia ,plaque of extracrani-al carotid artery ,ischemic stroke and cerebral arterial abnormal development were compared between the two groups .The Logistic single factor and multi-factor correlation analysis was adopted to evaluate the correlation between the aneurysm occurrence with the hemodynamic changes caused by atherosclerotic stenosis .Results Cystic multiple aneurysms were common in the observation group ,which was up to 4 in number ,the age was more than 60 years ,the majority was complicated by hypertension ,diabetes ,hyper-lipemia ,cerebral stroke ,plaque of extracranial carotid artery and intracranial arterial multiple stenosis were common .Aneurysms mostly occurred in intracranial artery with severe stenosis .The gender differences were unobvious .The control group was domina-ted by young patients .Single aneurysm was more common without intracranial artery multiple stenosis .The occurrence rate of ca-rotid arterial plaque and cerebral stroke was lower .The partial patients had smoking ,hyperlipidemia and hypertension .The Logistic regression analysis between the two groups showed that ischemic stroke ,cerebral arterial development abnormality and atheroscle-rosis plaque of extracranial carotid artery had significant correlation .Conclusion The aneurysm occurrence is related with cerebral arterial atherosclerotic stenosis ,which becomes the important factor leading to aneurysm formation and should arouse attention to conduct early diagnosis and early treatment .
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Objective To systematically evaluate the clinical outcomes of patients with multivessel diseases treated by fractional flow reserve (FFR) guided percutaneous coronary intervention (PCI) or other forms of treatment .Methods Some keywords inclu-ding FFR or fractional flow reserve ,percutaneous coronary intervention or PCI ,multivessel coronary artery disease were used to search randomized control trails(RCT) ,which compared outcomes of patients with multivessel disease treated by FFR guided PCI with other forms of treatment ,in Chinese and English database including CNKI ,VIP ,Wanfang ,Pubmed ,EMBASE and the web of science .The quality of included studies was evaluated by Jadad quality score and all the data was analyzed by stata 10 .0 .Results A total of 7 english literatures accumulating 2024 cases in experimental group and 7 284 cases in control group were included in this study .Compared with other forms of treatment ,patients with multivessel diseases treated by FFR-guided PCI had significantly low-er risk of myocardial infarction (RR=0 .72 ,P=0 .008) .Although the risk of death and major adverse cardiovascular events were al-so be reduced ,there were no statistically significant difference .Conclusion FFR-guided PCI is an effective treatment for multivessel disease ,but it is still needs further verification for the application in Chinese population .
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s and no restenosis was found in 3 patients according to cerebral angiography. Preliminary results show that PTAS in the management of the vertebrobasilar arterial stenosis is a safe and effective method.
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Objective To evaluate the therapeutic efficacy and safety of transcatheter closure of atrial septal defect (ASD) and patent ductus arteriosus (PDA) using Amplatzer occluder. Methods Routine cardiac catheterization and angiography were performed in 50 patients (23 male, 27 female, age ranging from 3 to 64 years old), including 19 cases of ASD and 31 cases of PDA under local or general anesthesia. After balloon sizing of the ASD, the optimal Amplazter septal occluder (ASO) was transmitted into the left atrial, and the left and right disks were released in turn. The Amplatzer occluder was completely released after transthoracic echocardiography confirmed that there was no residual shunts or new onset mitral valve regurgitation. The Amplatzer duct occluder (ADO) size was selected according to the narrowest point of PDA measured by angiography, and the occluder was released after the repeated angiography showed no residual shunts. Results ① The mean diameter of the ASD measured by balloon was 13-31 (23?6) mm and the diameter of ASO was (17-40) mm. The immediate closure rate was 100%. ② Angiography confirmed that closure of the ductus using ADO was achieved in 30 patients, and closure of the large size (12 mm) was achieved in 1 case of PDA patient using ASO (17 mm). No complications were encountered. Conclusion Transcatheter closure of ASD and PDA using Amplatzer device, with the advantages of simple operation, confirmative occlusion efficacy, minimal invasiveness, wide indications, and less complications, has a bright future of clinical application.
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Objective To investigate the bilateral flow-mediated dilation of brachial artery (BA-FMD) and nitroglycerin mediated dilation (BA-NMD) in patients with cerebral infarct, and to find out if the vasodilation of internal catotid artery after sublingual administration of nitroglycerin can be detected as a more direct way to reflect the vasodilation in patients with cerebral vascular diseases. Methods High resolution ultrasonic system was used to measure 13 patients with acute cerebral infarction. The diameter of brachial artery, internal carotid artery and common carotid artery was measured at relaxation, reactive congestion in the brachial artery and after sublingual administration of nitroglycerin. Meanwhile, the intima media thickness (IMT) and plaques of carotid artery was detected. Results Paralysis did not lead to differences in vasodilation of brachial artery (r=0.52, P=0.07). There was a correlation between ICA-NMD and BA-NMD (r=0.83, P=0.01). Conclusion There were no significant differences between brachial vasodilation in paretic and non-paretic limbs of patients with acute cerebral infarction. Ultrasonic measurement of ICA-NMD can be a more direct measure of the vasodilation of patients with cerebral infarction.
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Objective To analyze the change of the shear stress in atherosclerotic carotid artery of rabbits and its effect on the plaque and intimia-media pathological morphology. Methods Totally 36 male Japanese White rabbits were randomly divided into blank control group (n=6), sham operation control group (n=6) and the surgery group (n=24). The blank control group was fed by normal diet. The sham operation control group was fed by the high-cholesterol diet. The surgery group was fed by high-cholesterol diet and treated by air-drying. In the 2nd, 4th, 8th and 12th week after operation, the hemodynamic parameters were measured using Color Doppler Flow Imaging. Blood viscosity was determined and the degree of artery stenosis was showed by digital subtraction angiography (DSA). The stenosis rate, mean shear stress, intimia-media ratio and mean integrated optical densities (IOD) of media smooth muscle cells (SMC) were calculated respectively. Results The typical atherosclerotic plaque was presented in surgery group. The thickness of media and mean IOD of SMC were increased at the 2nd week after operation. However, following the increase of the stenosis rate and shear stress, the flow field was changed on the stenotic artery. The pathological morphology showed the character of vulnerable plaque such a large lipid core, thin fibrous cap, and plaque rupture at 4th, 8th week after operation. The media showed atrophy and became thin, mean IOD of SMC was decreased. Statistic analysis showed significant difference in the 2 week group compared with other group. Conclusion Following the increase in the degree of stenosis, the flow shear stress is increased, turbulent flow presents, and flow field changes on the stenotic artery. Thus the plaque become unstable , and the vessel occurs remodeling.
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Objective To investigate the expression of MMP-2 in rabbit carotid artery injured by airing drying. Methods Fifty-four rabbits were assigned to normal diet (n=18), fat diet (n=36), 18 of fat diet rabbits underwent airing drying of carotid intima after one-week fat diet. Then fed on fat diet after operation. All animals were sacrificed respectively at 1, 2, 3 months after airing drying (n=6 at each time piont), and MMP-2 expression was evaluated by immunohistochemistry. Results MMP-2 expression was low in the carotid of normal diet group, high in the fat diet group including the rabbits underwent airing drying with significant difference between them (P
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Objective To investigate the effectiveness,safety of the percutaneous transluminal angioplasty and stenting(PTAS) in the management of the vertebrobasilar stenosis.Methods From April 2003 to June 2004,the PTAS was performed in 28 patients with the vertebrobasilar stenosis.Results Among the 28 patients,the unilateral significant stenosis of the dominant vertebral artery was found in 18 patients,the bilateral stenosis of the vertebral artery in 4 patients,the tandem stenosis of the vertebral artery in 1 patient,the stenosis of the basilar artery in 2 patients.According to Mori's division,the type A occurred in 24 patients,the type B in 3 patients,the type C in 1 patient.The successful rate of stent implantation was 100% without any serious complication.Twenty-eight patients underwent PTAS with a mean pre-procedural vertebrobasilar stenosis of 81.3% and the residual stenosis was less than 10%.Over a mean 6-month follow-up in 17 patients,according to Malek's scale,the scale 1 was in 15 patients,the scale 2 in 2 patients.No restenosis was in 3 patients by the cerebral angiography.Conclusion PTAS in the management of the vertebrobasilar stenosis is a safe and effective method.Meanwhile,PTAS may alleviate the vertebrobasilar ischemia and prevent stroke of the vertebrobasilar system.
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Objective To explore the mechanisms of angiotensin Ⅱ (Ang Ⅱ) induced apoptosis of cultured cardiomyocytes of neonatal rats. Methods Cultured neonatal rat cardiomyocytes were divided into three groups. Cells in the control group were incubated in serum-free medium for 2, 6, 12, and 24 h. Cells in Ang Ⅱ group were incubated with Ang Ⅱ at the dose of 10 -7 mol/L for 2, 6, 12, and 24 h. Cells in Ang Ⅱ and Ang Ⅱ type 1 receptor antagonist group were incubated in medium containing 10 -7 mol/ L Ang Ⅱ plus 10 -5 mol/L irbesartan. The apoptotic cells were detected by TUNEL assay. The Bcl-2 protein expression was assessed by immunohistochemistry. Caspase-3 activity was measured by a fluorescent assay kit. Results The number of apoptotic cells in Ang Ⅱ group increased significantly in a time-dependent manner, accompanied by decreased Bcl-2 protein expression but increased activity of caspase-3. Treatment with irbesartan resulted in decreased number of apoptotic cells and decreased activity of caspase-3. Conclusion Angiotensin Ⅱ could induce the apoptosis of neonatal rat cardiomyocytes through the caspase-dependent pathway, which might be mediated by Ang Ⅱ type 1 receptor. Bcl-2 may participate in the regulation.
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Objective To investigate the effect of brain microvascular endothelial cells (BMECs) on mesenchymal stem cells (MSCs) expressing fetal liver kinase-1(Flk-1) and von Willebrand factor (vWF) under normal and hypoxic conditions. Methods Human bone marrow MSCs and rat BMECs were isolated, cultured and identified. We used direct and indirect co-culture to induce the differentiation of MSCs. The expression of Flk-1 and vWF after induction was observed and analyzed by flow cytometry and immunofluorescence staining. Results Undifferentiated MSCs did not express Flk-1 or vWF. In indirect co-culture group, indirect co-culture under hypoxic conditions induced (7.58?0.58)% (n=6, P=0.034) MSCs to express Flk-1 but not vWF, while in normoxic indirect co-culture, MSCs expressed neither. In direct co-culture group, after 5-day direct co-culture with BMECs under normoxia or hypoxia, MSCs expressing Flk-1 accounted for (13.76?1.67)% (n=6, P
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30%. For inferior genicular artery lesions,only balloon angioplasty were carried out. All patients were followed up for 6 months and 12 months to assess of restenosis and clinical efficacy. Results All the patients' therapy was successful,their clinical symptoms were improved or disappeared. The 6-month follow-up showed that restenosis rates were 5.5%,16.7% and 25% respectively in the iliac artery,femoral popliteal artery,and inferior genicular artery. The rates in 12-month follow-up were 11.1%,33.3%,and 75% correspondingly. Conclusion Angioplasty and stent implantation are safe and effective in treatment of lower limb atherosclerosis obliterans. Standardized postoperative anti-platelet,anticoagulant,and anti-lipid therapy is essential to maintain blood vessel recanalization.
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Objective To investigate the role of angiotensin Ⅱ receptors in metabolism of m yocardial collagen. Methods The collagen volume fraction(CVF), perivascular circumferential area(PVCA), hydroproline concentration(HC), ratio o f collagen type Ⅰto type Ⅲ(Ⅰ/Ⅲ),angiotensin Ⅱ(AngⅡ) content and the maximal binding capaci ty (Bmax) of ATRs were studied. The methods of radioimmunoassay(RIA),biochemistry assay, and pathological examin ation were used. Results Ventricular myocardial CVF, PVCA, HC, Ⅰ/Ⅲ, AngⅡ and B max of ATRs in WKY rats were significantly higher than those in sham -operation(SO)(P<0.05 or P<0.01),suggesting the collagen was abnormal ly accumulated in rats heart muscles. AngⅡ was positivily correlated with HC(r1=0.9045, P<0.01). After treament of Irbesartan, All above parameter were reduced significantly(P<0.05 or P<0.01), abnormally accumulated collagen was disap peared. While after treament of CGP42112A,an ATR2 antagonist, Bmax of ATRs was markedly decreased(P<0 .01), but CVF, PVCA, HC,Ⅰ/Ⅲ, AngⅡ showed little changes(P >0.05). Conclusion Obvious hyperplasia of myocardial collagens and remode ling of collagen network occurred after pressure overload. Local produced AngⅡ involves in the process,it's effects is mainly mediated by angiotensin Ⅱ 1 type receptor(ATR1)
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AIM:To investigate the paracrine actions of mesenchymal stem cells(MSCs)to brain microvascular endothelial cells(BMECs)in hypoxic conditions.METHODS:Human bone marrow MSCs and rat BMECs were isolated,cultured and identified.The contents of VEGF and MMP-9 were confirmed using ELISA assays of the conditioned media.The transendothelial electrical resistance(TEER)was detected to reflect the permeability of the BMECs monolayer.The effects of different conditioned media on BMECs were investigated in hypoxic conditions.RESULTS:The contents of VEGF and MMP-9 in conditioned media were induced to increase significantly by the hypoxic stress,which were much lower in BMECs conditioned media than that in MSCs conditioned media.Hypoxia induced a significant increase in VEGF and MMP-9 in MSCs conditioned media collected in comparison to those in normal conditions.In hypoxic conditions,MSCs conditioned media enhanced the proliferation(optical density values:0.947?0.103 vs 0.254?0.024,P
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AIM: To investigate the mechanism of vascular smooth muscle cells (VSMC) apoptosis after balloon injury. METHODS: VSMCs apoptosis, Bax protein and Bcl-2 protein was measured by terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) and immunohistochemical technique after balloon injury.RESULTS: VSMCs apoptosis occurred in vascular media at 3 days after balloon injury and reached a peak in media and intima where apoptosis was mainly present at 7 days, then decreased. At 28 days after balloon injury, only a few apoptosis cells were in intima. Irbesartan significantly increased VSMCs apoptosis ( P
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OBJECTIVE: This study aimed at understanding of the role of calcium homeostasis in cardiomyocytes from hypoxia, burnt serum-induced injury. METHODS: Alterations in cytosolic free calcium concentration (Ca(i)), calcium influx and viability of the cardiomyocytes in vitro after hypoxia, burnt serum stimulus were observed. RESULTS: Ca(i) increased markedly, in the meantime, the cellular transmembrane calcium influx increased and the viability of the cells decreased significantly following hypoxia, burnt serum-induced injury. CONCLUSIONS: In our study cytosolic calcium ion was transported abnormally in the cardiomyocytes after burn, to result in Ca(i) increase and runaway calcium homeostasis, thus the normal cellular function was disturbed. This may be one of the important factors in the development of burn-induced cardiac injury.
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50% and types 2 and 3 of plaque morphology) and mild lesion group (MG, narrowness of luminal diameter
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Hemodynamic and clinical observations were performed on 15 patients with severe congestive heart failure treated with Chinese-made milrinone.It was found that after treatment with milrinone,cardiac index was significantly increased,pulmonary capillary wedge pressure,systemic vascular resistance,and pulmonary vascular resistance were significantly decreased,and heart rate and myocardialoxygen consumption remained unchanged.Tolerance exercise test was prolonged and plasma cyclic AMP was increased.No thrombocytopenia or pro-arrhythmic effect was observed.The total clinical efficacy of the drug was 86.7%.These facts suggest that the Chinese-made milrinone is the durg of choice for the management of patients with congestive heart failure.
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AIM and METHODS: To investigate the role of angiotensin Ⅱ recepters(ATRs) in overload pressure-induced left ventricular hypertrophy. The rat abdominal aortic constraction model was adopted. At 10th week after operating, angiotensin Ⅱ in myocardium was measured by radioimmunoassay,tissue ATRs and its subtype were analysed by radioligand binding assay. RESULTS: The AngⅡ content in the operated group was significantly higher than that of the control group, LVMI was positively correlated with AngⅡ(r=0.8066,P